On dreaming one's patient: reflections on an aspect of countertransference dreams

This paper explores the phenomenon of the countertransference dream. Until very recently, such dreams have tended to be seen as reflecting either unanalyzed difficulties in the analyst or unexamined conflicts in the analytic relationship. While the analyst's dream of his/her patient may represent such problems, the author argues that such dreams may also indicate the ways in which the analyst comes to know the patient on a deep, unconscious level by processing the patient's communicative projective identifications. Two extended clinical examples of the author's countertransference dreams are offered. The author also discusses the use of countertransference dreams in psychoanalytic supervision.     

Dreams and the holistic nature of interpersonal psychoanalytic experience

Patients’ dreams and analysts’ dreams about patients are assumed to reflect each analytic participant's attitude and psychic conduct toward the other, and an unconscious overlapping of psychic issues and struggles between them as well. This makes it possible to deal with dreams from one‐person and two‐person models of psychological functioning, as well as from an additional psychic dimension that is assumed to be a creation of the analysis itself. As a source of freely moving experience within both participants, one that is assumed to have a life and direction of its own, this latter dimension of analysis permits patient and analyst to undergo more freely the actual experience of the treatment as a modality that is separate from and prior to positivistically grounded determinations that can be made about either the patient or analyst individually, or about the two of them jointly.

This dimension of analysis is said also to reflect a holism that characterizes conscious and unconscious psychoanalytic experience. Dreams and unconsciously generated dreamlike clinical phenomena are presented to try to illustrate this holistic character of analytic work, and to show how either participant's psychic productions maybe used to evoke significant experiences and further clinical knowledge.     

From Freud’s dream-work to Bion’s work of dreaming: The changing conception of dreaming in psychoanalytic theory

Bion moved psychoanalytic theory from Freud's theory of dream-work to a concept of dreaming in which dreaming is the central aspect of all emotional functioning. In this paper, I first review historical, theoretical, and clinical aspects of dreaming as seen by Freud and Bion. I then propose two interconnected ideas that I believe reflect Bion’s split from Freud regarding the understanding of dreaming. Bion believed that all dreams are psychological works in progress and at one point suggested that all dreams contain elements that are akin to visual hallucinations. I explore and elaborate Bion’s ideas that all dreams contain aspects of emotional experience that are too disturbing to be dreamt, and that, in analysis, the patient brings a dream with the hope of receiving the analyst’s help in completing the unconscious work that was entirely or partially too disturbing for the patient to dream on his own. Freud views dreams as mental phenomena with which to understand how the mind functions, but believes that dreams are solely the ‘guardians of sleep,’ and not, in themselves, vehicles for unconscious psychological work and growth until they are interpreted by the analyst. Bion extends Freud's ideas, but also departs from Freud and re-conceives of dreaming as synonymous with unconscious emotional thinking – a process that continues both while we are awake and while we are asleep. From another somewhat puzzling perspective, he views dreams solely as manifestations of what the dreamer is unable to think.     

This art of psychoanalysis

It is the art of psychoanalysis in the making, a process inventing itself as it goes, that is the subject of this paper. The author articulates succinctly how he conceives of psychoanalysis, and offers a detailed clinical illustration. He suggests that each analysand unconsciously (and ambivalently) is seeking help in dreaming his 'night terrors' (his undreamt and undreamable dreams) and his 'nightmares' (his dreams that are interrupted when the pain of the emotional experience being dreamt exceeds his capacity for dreaming). Undreamable dreams are understood as manifestations of psychotic and psychically foreclosed aspects of the personality; interrupted dreams are viewed as reflections of neurotic and other non-psychotic parts of the personality. The analyst's task is to generate conditions that may allow the analysand-with the analyst's participation-to dream the patient's previously undreamable and interrupted dreams. A significant part of the analyst's participation in the patient's dreaming takes the form of the analyst's reverie experience. In the course of this conjoint work of dreaming in the analytic setting, the analyst may get to know the analysand sufficiently well for the analyst to be able to say something that is true to what is occurring at an unconscious level in the analytic relationship. The analyst's use of language contributes significantly to the possibility that the patient will be able to make use of what the analyst has said for purposes of dreaming his own experience, thereby dreaming himself more fully into existence.     

Incognito or not? the patient's subjective experience of the analyst's private life

This paper examines the meaning for the patient of the analyst's personal life and personality which are ostensibly banished from the consulting room. The therapist has a not‐always‐so‐secret “secret life”; that the patient is supposed to “not know”; about. Yet, more or less unconscious perceptions, impressions, and fantasies about extratherapeutic aspects of the analyst are omnipresent and significantly color the psychoanalytic enterprise.

Moreover the analyst as a person generally plays a critical and underacknowledged role in the patient's experience of the endeavor. Constructing multiple overlapping images of the analyst and of the analytic relationship, the patient discovers himself or herself in the matrix of these relationships with various images of the analytic other. The analysand is motivated to make sense of the analyst as wholly as possible, the better to place into context the analyst's interventions. The patient's resulting view of the analyst's subjective experience acts as a lens that filters and subtly alters the meaning of the analyst's communications.

I illustrate these points by relating my work with a patient whose dreams uncannily picked up on a (consciously) unknown aspect of my private life—my having a handicapped son. The treatment thereafter centered on the patient's identification with my child (as someone “disabled") and on the meaning of her having dreamt something so personal about her therapist.     

The analytic situation as a dynamic field. 1969

This paper discusses the consequences of the importance that recent ³ papers assign to the countertransference. When the latter acquires a theoretical and technical value equal to that of the transference, the analytic situation is configured as a dynamic bi‐personal field, and the phenomena occurring in it need to be formulated in bi‐personal terms. First, the field of the analytic situation is described, in its spatial, temporal and functional structure, and its triangular character (the present–absent third party in the bi‐personal field) is underlined. Then, the ambiguity of this field is emphasized, with special weight given to its bodily aspect (the bodily experiences of the analyst and the patient being particularly revealing of the unconscious situation in the field). The different dynamic structures or lines of orientation of the field are examined: the analytic contract, the configuration of the manifest material, the unconscious configuration – the unconscious bi‐personal phantasy manifesting itself in an interpretable point of urgency – that produces the structure of the field and its modifications. The authors describe the characteristics of this unconscious couple phantasy: its mobility and lack of definition, the importance of the phenomena of projective and introjective identification in its structuring. The authors go on to study the functioning of this field, which oscillates between mobilisation and stagnation, integration and splitting. Special reference is made to the concept of the split off unconscious ‘bastion’ as an extremely important technical problem. The analyst’s work is described as allowing oneself to be partially involved in the transference–countertransference micro‐neurosis or micro‐psychosis, and interpretation as a means of simultaneous recovery of parts of the analyst and the patient involved in the field. Finally, the authors describe the bi‐personal aspect of the act of insight that we experience in the analytic process.     

The Analyst as Comic and the Comic in Analysis: Reply to Commentary

This discussion elaborates aspects of the use of humor and jokes in clinical psychoanalysis. The use of humor, like dreams or other symmetrical processes, facilitates the patient's development of the capacity to symbolize unconscious experience and mitigates the need to evacuate unconscious experiences and fantasies into the external world. In focusing on specific clinical interventions I highlight three dimensions of the process: the concept of coconstruction in the emergence of humor in the psychoanalytic relationship, the authority of the patient's psychopathology and affective and cognitive development, and the analyst's willingness to take the risks of self-exposure and possibly hurting the patient implicit in the use of humor and jokes in the analytic relationship. Different forms of humor are described in relation to the different clinical situations, including mutually created jokes, caricatured enactments, cartoonlike images, and self-depreciating commentary on the analytic process. In using jokes and humor in psychoanalysis we introduce the possibility of pleasure within an intense, intimate moment which allows for the transformation of unacceptable aspects of both patient and analyst as they become joined within a broader human experience.     

Dissociation,the Analyst's Vulnerability,and the Body: Review of Awakening the Dreamer: Clinical Journeys by Philip M. Bromberg

This review praises Bromberg's rich and evocative new book for its clinical and theoretical usefulness and elaborates on three broad themes: the analyst's personal role in traumatic enactments, dissociative/addictive uses of the body, and the distinction between life-threatening and developmental trauma. Extending Bromberg's formulations, the author argues that in successful work with trauma survivors, the analyst must be actually (temporarily) traumatized as actual, personal vulnerabilities of the analyst are necessarily engaged. The analyst's vulnerability serves as an internal contact point, opening up a process of unconscious empathy with the patient and providing crucial validation of the patient's experience. The review also explores how bodily processes are used to further dissociation with eating disordered patients and how they become the source of treatment difficulties. When the patient's states of desire have been “detoured” into the body (where they are ruthlessly controlled or attacked) as well as into the relationship with food (where they are temporarily gratified), they are not as available to be mobilized in the analytic relationship. The review also questions Bromberg's assumption that the underlying dissociative mechanisms are the same for life-threatening trauma (or Posttraumatic Stress Disorder) and developmental (or relational) trauma.     

What's in a name: what analyst and patient call each other

Awkward moments often arise between patient and analyst involving the question, "What do we call each other?" The manner in which the dyad address each other contains material central to the patient's inner life. Names, like dreams, deserve a privileged status as providing a royal road into the paradoxical analytic relationship and the unconscious conflicts that feed it. Whether an analyst addresses the patient formally, informally, or not at all, awareness of the issues surrounding names is important.     

Enactment as Unconscious Communication

ABSTRACT

I explore the way in which unconscious primitive and nonsymbolic experience is communicated to the analyst’s unconscious through enactment. As the analyst receives the projections unconsciously, she is encouraged to enact aspects of the patient’s internal world. The analytic work then is through the understanding of these subtle and ubiquitous enactments. I value the work of understanding enactments as a rich and subtle pathway into the deepest levels of the patient’s unconscious. I explore the nature of this work and illustrate my point with clinical examples.     

Analytic process and dreaming about analysis

Dreams about the analytic session feature a manifest content in which the analytic setting is subject to distortion while the analyst appears undisguised. Such dreams are a consistent yet infrequent occurrence in most analyses. Their specificity consists in never reproducing the material conditions of the analysis as such. This paper puts forward the following hypothesis: dreams about the session relate to some aspects of the analyst's activity. In this sense, such dreams are indicative of the transference neurosis, prefiguring transference resistances to the analytic elaboration of key conflicts. The parts taken by the patient and by the analyst are discussed in terms of their ability to signal a deepening of the analysis.     

Where are you,my beloved?: On absence,loss, and the enigma of telepathic dreams

The subject of dream telepathy (especially patients' telepathic dreams) and related phenomena in the psychoanalytic context has been a controversial, disturbing ‘foreign body’ ever since it was introduced into psychoanalysis by Freud in 1921. Telepathy ‐ suffering (or intense feeling) at a distance (Greek: pathos + tele)‐is the transfer or communication of thoughts, impressions and information over distance between two people without the normal operation of the recognized sense organs. The author offers a comprehensive historical review of the psychoanalytic literature on this controversial issue, beginning with Freud' years‐long struggles over the possibility of thoughttransference and dream telepathy. She then describes her own analytic encounter over the years with five patients' telepathic dreams' dreams involving precise details of the time, place, sensory impressions, and experiential states that the analyst was in at that time, which the patients could not have known through ordinary sensory perception and communication. The author's ensuing explanation combines contributory factors involving patient, archaic communication and analyst. Each of these patients, in early childhood, had a mother who was emotionally absent‐within‐absence, due to the absence of a significant figure in her own life. This primary traumatic loss was imprinted in their nascent selves and inchoate relating to others, with a fixation on a nonverbal, archaic mode of communication. The patient's telepathic dream is formed as a search engine when the analyst is suddenly emotionally absent, in order to find the analyst and thus halt the process of abandonment and prevent collapse into the despair of the early traumatization. Hence, the telepathic dream embodies an enigmatic ‘impossible’ extreme of patient‐analyst deep‐level interconnectedness and unconscious communication in the analytic process. This paper is part of the author's endeavour to grasp the true experiential scope and therapeutic significance of this dimension of fundamental patient‐analyst interconnectedness.     

Bearing the unbearable: ancestral transmission through dreams and moving metaphors in the analtyic field

Abstract: This paper explores how untold and unresolved intergenerational trauma may be transmitted through unconscious channels of communication, manifesting in the dreams of descendants. Unwitting carriers for that which was too horrific for their ancestors to bear, descendants may enter analysis through an unconscious need to uncover past secrets, piece together ancestral histories before the keys to comprehending their terrible inheritance die with their forebears. They seek the relational containment of the analytic relationship to provide psychological conditions to bear the unbearable, know the unknowable, speak the unspeakable and redeem the unredeemable. In the case of ‘Rachael’, initial dreams gave rise to what Hobson (1984) called ‘moving metaphors of self’ in the analytic field. Dream imagery, projective and introjective processes in the transference‐countertransference dynamics gradually revealed an unknown ancestral history. I clarify the back and forth process from dream to waking dream thoughts to moving metaphors and differentiate the moving metaphor from a living symbol. I argue that the containment of the analytic relationship nested within the security of the analytic space is a necessary precondition for such healing processes to occur.     

DREAMING THE ANALYTIC SESSION: A CLINICAL ESSAY

This is a clinical paper in which the author describes analytic work in which he dreams the analytic session with three of his patients. He begins with a brief discussion of aspects of analytic theory that make up a good deal of the context for his clinical work. Central among these concepts are (1) the idea that the role of the analyst is to help the patient dream his previously “undreamt” and “interrupted” dreams; and (2) dreaming the analytic session involves engaging in the experience of dreaming the session with the patient and, at the same time, unconsciously (and at times consciously) understanding the dream. The author offers no “technique” for dreaming the analytic session. Each analyst must find his or her own way of dreaming each session with each patient. Dreaming the session is not something one works at; rather, one tries not to get in its way.     

The analytic third: implications for psychoanalytic theory and technique

The author views the analytic enterprise as centrally involving an effort on the part of the analyst to track the dialectical movement of individual subjectivity (of analyst and analysand) and intersubjectivity (the jointly created unconscious life of the analytic pair--the analytic third). In Part I of this paper, the author discusses clinical material in which he relies heavily on his reverie experiences to recognize and verbally symbolize what is occurring in the analytic relationship at an unconscious level. In Part II, the author conceives of projective identification as a form of the analytic third in which the individual subjectivities of analyst and analysand are subjugated to a co-created third subject of analysis. Successful analytic work involves a superseding of the subjugating third by means of mutual recognition of analyst and analysand as separate subjects and a reap-propriation of their (transformed) individual subjectivities.     

In-Between: Shapes of Subjectivities in the Analytic Situation

Starting from concepts that Winnicott developed and that are unexpectedly near to postmodern concepts, I attempt to map some features of the complex territory that lies between analyst and patient from the viewpoint of the relationship that exists between subjectivity and objectivity. In the first section, I give a personal reading of Winnicottian model, emphasizing the idea that the subject’s unconscious acts upon and transforms the object’s (thereby putting in motion further unconscious processes within the object). Then I highlight the presence, in the transference, of various levels of communication and of a paradoxical multidimensionality that upsets the traditional space-time categories and also upsets the analyst’s mental stance. In the third section, I present a new form of countertransference (pervasive), through which the patient’s unconscious creates a sensory environment of proto-emotions and atmospheres, of states and rhythms, that have permeated it and that, due to their intensity and nature, arrived there without symbolization. Finally, I attempt to demonstrate how the patient can undergo psychic change only if the analyst has, himself, inhabited an analogous process of transformation in response to the disturbances arising within the analytical relationship. The clinical-theoretical stance emerging from these reflections sees the relation to the other, to oneself, and to the world as made possible by subjective creation always taking place in the unconscious.     

Unconscious Communication in the Intersubjective Analytic Field at Times of Separation,Loss, and Termination

ABSTRACT

Unconscious communication, like transference-countertransference, is ubiquitous in life and in the psychoanalytic process. Regardless of a clinician’s theoretical perspective, and despite differences in clinical technique, Freud’s advice to turn our unconscious to the patient’s unconscious “like a receptive organ” has guided generations of analysts toward deeper exploration of the countertransference in the intersubjective analytic field (Freud, 1912a, p. 115). In this clinical article, the recognition and use of unconscious communication, from the ordinary to the more extraordinary or uncanny, is described at moments of separation as harbinger of loss and, ultimately, termination. Such moments hold potential for a depth of emotional resonance with and accessibility to our patient’s psychic realities that may otherwise be unavailable due to our systemic defense against a shared existential anxiety that all things come to an end. The emergence of unconscious communication via the analyst’s reverie and dreams are considered an opening of potential space where ending can be conceived as a bearable thought—a transitional organizing experience for the dyad.     

One form of self-analysis

Beginning with Freud, psychoanalysts have discovered media through which they may achieve a self-analytic experience (for example, by use of dreams, fantasies, reveries, memories, and even visual images). Each of these media is a kind of "fiction" created by the analyst that provides an imaginative space where he or she may gain access to unconscious life. The author demonstrates how a generative self-analytic experience may be accomplished through the medium of psychoanalytic writing: a fictional autobiographical form of writing through which a self-analytic experience is created that has much in common with the analytic experience created by the analyst and analysand.     

Vitalizing Enactment: A Relational Exploration

Drawing from her extensive work with deeply disturbed children Alvarez (2012) theorized a form of intervention termed “vitalization” in which the analyst actively reaches out to contact and “reclaim” her most inaccessible patients, engaging them in the world of emotions and relationships. In this paper I consider Alvarez’s ideas through the lens of Relational thought, reconceptualizing vitalization as a unique form of enactment that can draw the analytic dyad from deadened impasse into enlivened contact. In vitalizing enactment embryonic affects, hopes, and longings find expression and are potentiated for patient and analyst alike. This is a view of enactment as a progressive and creative lived experience, rather than an unconscious collision to be survived and symbolized. I contextualize vitalizing enactment in relation to Alvarez’s original formulations as well as relevant contemporary theories and present a clinical vignette to illustrate this paper’s themes.